Lectures on subjects connected with clinical medicine

Preface

The Lectures contained in this volume are the first of a series which I am engaged in giving to the Students of St. Bartholomew's Hospital. It is, however, no part of my duty, as one of the physicians to St. Bartholomew's, to deliver lectures. The obligations of my office are limited to the wards of the Hospital; where my business is to attend the sick, and to aid the studies of those who seek the knowledge of disease at the bedside of the patient.

But, since there are many things which must be first understood, in order that our inquiries at the bedside may be pursued more profitably, I have thought that the practical student had a further claim upon me for any information 1 could afford him which might be necessary or conducive to his purpose. And thus I have been led to give occasional lectures " On Subjects connected with Clinical Medicine."

Considering the time of life at which the majority of those who are intended to practise physic begin their professional education, few can be supposed at once to understand the objects with which it is conversant. I have therefore endeavoured to put in as clear a light as I could, what is the nature of Facts and Opinions, and Theories and Principles, in medicine; and what concern the clinical student has with each ; and how important it is for him rightly to distinguish between one and the other.

With respect to the mode of conducting his inquiries at the bedside, I have sufforested to him how to observe and what to observe ; what demands his present attention and what may wait the season of his more mature experience; what books to read and what to abstain from reading; and the sort of knowledge which is principally auxiliary to clinical medicine.

But the subject to which I have chiefly desired to direct the student's attention is Semeiology, or the Doctrine of Symptoms; not for the sake of pointing out the symptoms of particular diseases, but of showing what symptoms are in their own nature; what sense, or rather what various senses, they bear; and what is their import and value in enabling us to judge of all diseases which are capable of being known and treated in the living ufan. For this purpose I

[y PREFACE.

have constructed no system, and have adopted only so much of arrangement as was necessary for the convenient discussion of the subject.

The Lectures, now published, embrace one part only of Semeiology. The inquiry, as far as it has gone, has been occupied with the evidence, which each organ is capable of furnishing, of its own diseases by symptoms directly referrible to itself, and involved in the actual state of its sensations and functions and structure. This is the simplest and the easiest part of Semeiology.

Among such direct symptoms I have chiefly dwelt upon those by which Auscultation has enabled us to make discovery of diseases of the lungs.

Auscultation is capable, I have thought, of being greatly simplified for practical purposes. At all events, unless it be so it can never be successfully taught ; the knowledge derived from it must be confined to a few physicians of hospitals, and the profession at large can never expect much benefit from its use.

Whether I have succeeded in accomplishing what I think so desirable, and have cleared Auscultation of its mystery in any degree, others must judge. But thus much I can safely say, that the intelligent student, by attending to the few characteristic sounds which I have pointed out, and taking pains to understand their import, and guarding himself against over-refinement, is able in a few weeks to discern the leading truths connected with Auscultation, and in a few months to use it and trust it as his safest guide in the diagnosis of pulmonary diseases.

Such are the objects which these Lectures have in view. They do not pretend to teach the clinical student any single thing peremptorily or dogmatically, but only to furnish him with certain aids and assistances by which he may be better able to teach himself.